Step 3 YOUR INFORMATION

Salutation*

First name*

Last name*

Address line 1*

Address line 2

City*

Province*

Postal code*

Email*

Phone*

Phone

Allow us to send you text alerts and reminders, including information regarding your claims process (i.e., when your claim is paid or if we need more information). Standard text message rates from your carrier may apply.

You prefer to be contacted via*

By accepting the free trial of insurance on behalf of the new pet owner, you confirm you have collected the appropriate and necessary consent authorized under applicable privacy law and CASL to allow PTZ Insurance Services Ltd. to contact the pet owner regarding their trial of insurance and other insurance products or services, special offers and/or news updates offered by PTZ via email, pre-recorded/automated messages/text messages at the telephone, including mobile number, and email address provided above. You understand that by not collecting consent the new pet owner will not qualify for the trial of insurance other insurance products or services, special offers and/or news updates offered by PTZ. Pet owners may withdraw their consent at any time by calling 1-800-364-8422.

Email and consent to contact are required for electronic registration on the adoption portal. To continue to register the Pets Plus Us Adoption Voucher without email address or consent to contact please have the adopter call 1-800-364-8422.

Step 3 SECOND CONTACT (OPTIONAL)

Salutation

First name

Last name

Email

Phone

Phone

Step 4 YOUR CONSENT

An opportunity to sample pet insurance coverage for 6 weeks, this coverage provides $500 in benefits over the trial period and you pay no premium for this protection. Another benefit you will receive is that, should your pet develop any medical conditions during this trial period, you can still extend or ‘roll-over’ your coverage into any other paid Pets Plus Us coverage and we may cover conditions that developed during the 6 week trial period.

Only one (1) waiting period of 48 hours applies.

Please note: if your application is approved, there is no coverage for expenses resulting from accident, onset of illness or other triggering event occurring within 48 hours of the start date of this trial coverage. Pre-existing conditions are not covered.

We will reimburse you for 80% of the cost of any covered treatment for conditions arising from accident(s) or illness(es). You are also responsible for a $100 deductible per incident. Total benefits available under this coverage are $500.

• This form must be completed and received by Pets Plus Us within 10 days of your pet’s adoption.
• All dogs and cats aged 7 weeks and older are eligible for trial coverage. The pet owner must be 18 years of age or older to participate in this offer.
• This coverage is valid for a period of 6 weeks starting at 12:01 on the day of your adoption provided you have activated your adoption trial coverage online or on the phone.
• Only one voucher per each pet’s lifetime.

I hereby apply for Trial Coverage and understand that I am receiving 6 weeks and up to $500 in Accident & Illness insurance coverage.

The information herein is summarized. All pet insurance plans have limitations and exclusions. Specific products, features, rates, and discounts may vary by province/territory, eligibility, and are subject to change.

Medical conditions that are noted, symptomatic or diagnosed prior to enrollment, or during a waiting period are pre-existing to Coverage and not available for coverage. This advertisement is an outline only, the actual policy issued terms and conditions will prevail.